跟骨外侧柱短缩截骨治疗儿童脑瘫马蹄内翻足  

Using lateral column of calcaneal osteotomy technique for treatment of clubfoot deformity in children with cerebral palsy

作　　者：董震 王林涛 李伟 李友 吕杰 厉亚男 李帅 

机构地区：[1]青岛市妇女儿童医院小儿骨科,山东青岛266034

出　　处：《足踝外科电子杂志》2016年第2期26-28,共3页Electronic Journal of Foot and Ankle Surgery

摘　　要：目的探索应用跟骨外侧柱短缩截骨治疗痉挛性脑瘫马蹄内翻足的手术方法和术后疗效。方法选取2011年1月至2014年12月收治的痉挛性脑瘫马蹄内翻足患儿10例(14足),采用跟骨外侧柱短缩截骨胫前肌外移跟腱延长伊式架外固定手术方式治疗儿童痉挛性脑瘫马蹄内翻足。术前采用痉挛性马蹄内翻足分型评估,本组患儿均为痉挛性脑瘫马蹄内翻足合并跟骨内翻畸形。术中采用跟骨外侧柱矩形截骨,跟腱延长,胫前肌外移,伊式架外固定手术。术后调整伊氏架以求良好力线。术后随访观察患儿患足形态特征、功能状况及X线情况,采用国际马蹄足畸形研究学组(ICFSG)评分系统评分。结果所有病例均获随访,平均随访时间36个月,足背伸较术前有明显改善,术前及术后各指标比较差异有统计学意义(P<0.05)。术后未见严重并发症,外形及行走功能明显改善,患足背伸肌力好。结论跟骨外侧柱矩形短缩截骨术可有效减少足外侧柱长度,增大了距下复合体的间隙,从而改善患儿的行走步态,是治疗痉挛性脑瘫马蹄内翻足疗效满意的手术方式。Objective To explore the operative methods and postoperative effects of the treatment of spastic cerebral palsy with lateral column of ealeaneal osteotomy technique.Methods Surgery was undertaken on 14 spastic equinus feet in 10 patients from 2011 January to 2014 December.According to the classification assessment of clubfoot deformity made preoperatively,all of the children included in the present study are patients with equinovarns and ealeaneus varus deformity in children with cerebral palsy.The procedure we performed In the operation eonsistes of lateral column of ealeaneal osteotomy,the elongation of tendo ealeaneus,as well as anterior tibial tendon transfer supplemented by lizarov method.After the operation,we followed up the patients to observe the morphological characteristics,functional status and X-ray manifestations according to the international club foot study group （ICFSG） scoring system. Results All eases were followed up and the average follow-up time was 36 months.The back extension of the foot of the patients was significantly improved postoperatively and the difference was statistically significant between preoperative and postoperative （P〈0.05）. Among all the patients ,there were no serious complications.The patients feet＇ s shape and walking function were significantly improved and the strength of dorsal stretch of the foot was good. Conclusion We propose lateral column of ealeaneal osteotomy techniques in the surgical treatment of clubfoot deformity in children with cerebral palsy as a reliable corrective surgical procedure on the basis of the effective shortening of the foot length of the lateral column and an increase in the gap among the complex under the talus.

关 键 词：跟骨截骨术 痉挛性马蹄足 脑瘫 儿童 

分 类 号：R726.8[医药卫生—儿科]